esketamine anesthesia in thoracic surgery

Conditions: General Anesthesia; Thoracic Surgery

Summary: esketamine group was induced with esketamine 0.5 mg/kg, propofol 2 mg/kg, and rocuronium bromide 0.9 mg/kg. anesthesia is maintained with propofol 5 mg/kg/h and esketamine 0.5 mg/kg/h. anesthesia induction in the opioid group sufentanil 0.5 ug/kg, propofol 2 mg/kg, rocuronium bromide 0.9 mg/kg. anesthesia is maintained with propofol 5 mg/kg/h and remifentanil 1 ug/kg/h.

before anesthesia induction, radial artery puncture and catheterization under local anesthesia for manometry, and intravenous pentethylquine hydrochloride 1 mg and dexamethasone 5 mg were given. anesthesia-induced opioid group (group a) received intravenous sufentanil 0.5 ug/kg, and esketamine group (group e) received intravenous esketamine 0.5 mg/kg. subsequently, both groups were sequentially injected with intravenous propofol 2 mg/kg and rocuronium bromide 0.9 mg/kg. after the onset of rocuronium bromide, the left double-lumen bronchial intubation was guided by a video laryngoscope, the correct position of the catheter was confirmed by bronchoscope, and the anesthesia machine was connected to the anesthesia machine for mechanical ventilation after fixation, with a tidal volume of 6 ml/kg (ideal body weight), a respiratory rate of 12\~18 breaths/min, and end-expiratory carbon dioxide partial pressure at 35\~40 mmhg. intraoperative anesthesia maintenance opioid group was injected with intravenous injection of propofol (5 mg/kg/h) and remifentanil (1 ug/kg/h), and esketamine group was pumped with propofol (5 mg/kg/h) and esketamine (0.5 mg/kg/h). after the lateral decubitus position is set up and the lateral paravertebral nerve block (t4, t6 levels 0.5% ropivacaine 10 ml each) is performed under ultrasound guidance, and the anesthesiologist is responsible for the complications and accidents that occur during the routine management of anesthesia. after the operation, they were given 200 mg of sugammadex sodium as an antagonistic residual muscle relaxant, and after being extubated awakely, they were sent to pacu for continued pcia treatment and observation, and returned to the thoracic surgery ward for further treatment after reaching the discharge criteria.

Eligibility criteria:
inclusion criteria: 1. asa scores 1 \~ 2 2. age \> 18 years and \< 70 years 3. thoracoscopic segmentectomy or lobectomy is proposed under general anesthesia 4. patient controlled intravenous analgesia was planned 5. sign informed consent. exclusion criteria: 1. bmi\>30 kg/m2 or \< 19 kg/m2; 2. preoperative use of opioids, acute and chronic pain or hyperalgesia; 3. preoperative coronary atherosclerotic heart disease, significant ischemic heart disease, severe angina, heart failure, valvular disease or other heart disease; 4. severe hepatic and renal insufficiency before operation; 5. a history of mental illness or alcoholism; 6. a history of alcohol or drug abuse; 7. cranial pressure, intraocular pressure or suffering from glaucoma; 8. poorly controlled or untreated hypertension; 9. preeclampsia or eclampsia; 10. untreated and undertreated hyperthyroidism; 11. the numerical rating scale (nrs) cannot be used.